Healthcare Provider Details

I. General information

NPI: 1912862202
Provider Name (Legal Business Name): PIKE ROAD PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9558 VAUGHN ROAD
PIKE ROAD AL
36064
US

IV. Provider business mailing address

9558 VAUGHN ROAD
PIKE ROAD AL
36064
US

V. Phone/Fax

Practice location:
  • Phone: 334-398-7765
  • Fax: 334-398-7841
Mailing address:
  • Phone: 334-398-7765
  • Fax: 334-398-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEREMY MICHAEL NOLAN
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 334-202-1104